Sex, Gender, and Women's Heart Health: How Women's Heart Programs Address the Knowledge Gap.

This article aims to bridge existing knowledge gaps that impact clinical cardiovascular care and outcomes for women in Canada. The authors discuss various aspects of women's heart health, emphasizing the efficacy of multidisciplinary care in promoting women's well-being. The article also identifies the impact of national women's heart health campaigns and the value of peer support in improving outcomes. The article addresses the particular risks that women face, such as pregnancy-related complications and hormone replacement therapy, all of which are associated with cardiovascular events, and highlights the differences in ischemic symptoms between men and women. Despite improvements in acute event outcomes, challenges persist in accessing timely ambulatory care, particularly for women. Canada has responded to these challenges by introducing Women Heart Programs, which offer tailored programs, support groups, and specialized testing. However, these programs remain few in number and are found only in urban settings. Overall, this review identifies sex and gender factors related to women's heart health, underscoring the importance of specialized programs and multidisciplinary care in improving women's cardiovascular health.

Cet article vise à répondre aux incertitudes actuelles qui se répercutent sur les soins cardiovasculaires et les issues cliniques chez les femmes au Canada. Les auteurs abordent différents aspects de la santé cardiaque des femmes, mettant l'accent sur l'efficacité des soins multidisciplinaires pour améliorer le bien-être des femmes. L'article présente également l'effet des campagnes nationales sur la santé cardiaque des femmes et l'importance de l'entraide entre collègues pour améliorer les résultats. L'article traite des risques particuliers touchant les femmes, comme les complications liées à la grossesse et l'hormonothérapie substitutive, qui sont toutes associées à des événements cardiovasculaires, et il souligne les différences entre les hommes et les femmes pour ce qui est des symptômes ischémiques. Bien que des améliorations aient été observées quant à l'issue des événements aigus, des difficultés persistent sur le plan de l'accès rapide à des soins ambulatoires, surtout pour les femmes. Le Canada a répondu à ces difficultés en créant des programmes pour la santé cardiaque des femmes, qui offrent des services adaptés, des groupes de soutien et des analyses spécialisées. Cependant, ils sont encore peu nombreux et accessibles seulement en milieu urbain. Dans l'ensemble, cette analyse définit les facteurs liés au sexe et au genre qui interviennent dans la santé cardiaque des femmes, soulignant l'importance de mettre en place des programmes spécialisés et des soins multidisciplinaires pour améliorer la santé cardiovasculaire des femmes.

The Importance of Nontraditional and Sex-Specific Risk Factors in Young Women With Vasomotor Nonobstructive vs Obstructive Coronary Syndromes.

Background: Heart disease is the leading cause of premature death for women in Canada. Ischemic heart disease is categorized as myocardial infarction (MI) with no obstructive coronary artery disease (MINOCA), ischemia with no obstructive coronary arteries (INOCA), and atherosclerotic obstructive coronary artery disease (CAD) with MI (MI-CAD) or without MI (non-MI-CAD). This study aims to study the prevalence of traditional and nontraditional ischemic heart disease risk factors and their relationships with (M)INOCA, compared to MI-CAD and non-MI-CAD in young women. Methods: This study investigated women who presented with premature (at age ≤ 55 years) vasomotor entities of (M)INOCA or obstructive CAD confirmed by coronary angiography, who are currently enrolled in either the Leslie Diamond Women's Heart Health Clinic Registry (WHC) or the Study to Avoid Cardiovascular Events in British Columbia (SAVEBC). Univariable and multivariable regression models were applied to investigate associations of risk factors with odds of (M)INOCA, MI-CAD, and non-MI-CAD. Results: A total of 254 women enrolled between 2015 and 2022 were analyzed, as follows: 77 with INOCA and 37 with MINOCA from the registry, and 66 with non-MI-CAD and 74 with MI-CAD from the study. Regression analyses demonstrated that migraines and preeclampsia or gestational hypertension were the most significant risk factors, with a higher likelihood of being associated with premature (M)INOCA, relative to obstructive CAD. Conversely, the presence of diabetes and a current or previous smoking history had the highest likelihood of being associated with premature CAD. Conclusions: The risk factor profiles of patients with premature (M)INOCA, compared to obstructive CAD, have significant differences.

Contexte: Au Canada, la cardiopathie est la principale cause de décès prématuré chez les femmes. La cardiopathie ischémique est catégorisée comme suit : infarctus du myocarde (IM) en l'absence de coronaropathie obstructive (MINOCA), ischémie sans obstruction des artères coronaires (INOCA) et athérosclérose coronaire obstructive accompagnée d'un IM ou sans IM. La présente étude vise à examiner la prévalence des facteurs de risque classiques et non classiques de cardiopathie ischémique et leurs liens avec le (M)INOCA, comparativement à l'athérosclérose coronaire obstructive accompagnée d'un IM ou sans IM chez les femmes jeunes. Méthodologie: Cette étude portait sur des femmes qui avaient prématurément (55 ans ou moins) souffert d'un (M)INOCA ou d'une coronaropathie obstructive confirmés par coronarographie et qui étaient inscrites au registre de la Leslie Diamond Women's Heart Health Clinic (WHC) ou qui participaient à l'étude visant à éviter les événements cardiovasculaires en Colombie-Britannique (Study toAvoid CardiovascularEvents inBC; SAVEBC). Des modèles de régression univariés et multivariés ont été utilisés pour explorer les associations entre les facteurs de risque et les probabilités de (M)INOCA, ainsi que d'athérosclérose coronaire obstructive accompagnée ou non d'un IM. Résultats: Au total, 254 femmes inscrites de 2015 à 2022 ont été recensées, soit 77 présentant une INOCA et 37, un MINOCA selon le registre WHC, et 66 présentant une athérosclérose coronaire obstructive sans IM et 74, une athérosclérose coronaire obstructive accompagnée d'un IM selon l'étude SAVEBC. Les analyses de régression ont démontré que les migraines et la prééclampsie ou l'hypertension gestationnelle étaient les facteurs de risque les plus importants associés à une probabilité la plus élevée de (M)INOCA comparativement à une coronaropathie obstructive. En revanche, la présence d'un diabète et d'un tabagisme actuel ou passé était associée à la probabilité la plus élevée de coronaropathie prématurée. Conclusions: Il existe d'importantes différences pour ce qui est des profils de facteurs de risque des patientes ayant prématurément souffert d'un (M)INOCA en comparaison d'une coronaropathie obstructive.

One-Year Prospective Follow-up of Women With INOCA and MINOCA at a Canadian Women's Heart Centre.

BACKGROUND: Many women with cardiac chest pain and ischemia or myocardial infarction have no obstructive coronary artery disease (INOCA or MINOCA). Studies suggest that these patients have a decreased quality of life and are at increased risk of cardiovascular events. Our study reports 1-year quality of life, frequency of angina, and outcomes following entry into a multidisciplinary Women's Heart Centre (WHC). METHODS: Patients with INOCA and MINOCA completed questionnaires on baseline demographics and clinical presentation. At 1-year, frequency of chest pain, quality of life, depression and anxiety symptoms, and cardiovascular outcomes were reported and compared with baseline. RESULTS: A total of 154 women with nonobstructive coronary artery disease were included in this study (112 patients with INOCA and 42 with MINOCA). Median age was 59 years, and the most common referral was for chest pain (94% in INOCA and 66% in MINOCA). At baseline, 64% of patients with INOCA and 43% of patients with MINOCA did not have specific diagnoses. Following investigations in the WHC, 71.4% of patients with INOCA established a new or a changed diagnosis (most common was coronary microvascular dysfunction at 68%), whereas 60% of patients with MINOCA established new or changed diagnoses (the most common of which was coronary vasospasm at 60%). At 1-year, participants had significantly decreased chest pain, improved quality of life, and improved mental health. CONCLUSIONS: A multidisciplinary WHC significantly increases the yield of a specific diagnosis in patients with INOCA and MINOCA. Further, attending a WHC could significantly improve the clinical and psychological outcomes of women with INOCA and MINOCA.

A case report of pericardial constriction with coexisting severe left main coronary artery disease.

Background: Constrictive pericarditis (CP) is a rare condition in which the pericardium becomes progressively fibrotic and non-compliant leading to impaired ventricular filling and overt heart failure. While CP shares many clinical and haemodynamic similarities with restrictive cardiomyopathy, differentiation of these diseases is crucial as CP is potentially curative through pericardiectomy. Here, we present a case of proven pericardial constriction with atypical haemodynamics in a patient presenting with heart failure and severe left main coronary artery disease (CAD). Case summary: A 69-year-old female with a history of hypertension and paroxysmal atrial fibrillation presented with persistent heart failure refractory to diuretics. Ischaemic and infiltrative work-up were found to be negative with magnetic resonance imaging demonstrating trace pericardial fluid and thickening of the pericardium. Echocardiogram and right-heart catheterization demonstrated atypical haemodynamics suggestive of but not conclusive for CP, with coronary angiogram demonstrating severe left main CAD. Ultimately, the patient underwent coronary artery bypass grafting along with pericardiectomy and pericardial biopsy demonstrating constrictive physiology. Discussion: We suspect the inconclusive nature of the echocardiogram and cardiac catheterization was likely secondary to severe CAD impairing left ventricular relaxation and dampening ventricular interdependence. As such, clinicians should consider the possibility of coexistent severe CAD in patients with a clinical suspicion of CP, but inconclusive haemodynamics.

Sex differences in non-obstructive coronary artery disease.

Ischaemic heart disease is a leading cause of morbidity and mortality in both women and men. Compared with men, symptomatic women who are suspected of having myocardial ischaemia are more likely to have no obstructive coronary artery disease (CAD) on coronary angiography. Coronary vasomotor disorders and coronary microvascular dysfunction (CMD) have been increasingly recognized as important contributors to angina and adverse outcomes in patients with no obstructive CAD. CMD from functional and structural abnormalities in the microvasculature is associated with adverse cardiac events and mortality in both sexes. Women may be particularly susceptible to vasomotor disorders and CMD due to unique factors such as inflammation, mental stress, autonomic, and neuroendocrine dysfunction, which predispose to endothelial dysfunction and CMD. CMD can be detected with coronary reactivity testing and non-invasive imaging modalities; however, it remains underdiagnosed. This review focuses on sex differences in presentation, pathophysiologic risk factors, diagnostic testing, and prognosis of CMD.

Yield of Cardiac Magnetic Resonance Imaging in Patients With Acute Coronary Syndrome and No Obstructive Coronary Artery Disease.

PURPOSE: Ten percent to 25% of women and 6%-10% of men with acute coronary syndrome (ACS) are found to have no obstructive coronary artery disease (CAD) on coronary computed tomography angiogram or invasive coronary angiography. The etiology of presentation is often unclear. We examined the diagnostic yield of cardiac magnetic resonance imaging (CMR) in patients with signs and symptoms suggestive of an ACS and no obstructive CAD. METHODS: We retrospectively studied patients with signs and symptoms suggestive of an ACS and no obstructive CAD on coronary computed tomography angiogram or invasive coronary angiography who had CMR performed at St. Paul's Hospital, British Columbia, Canada, from 2013 to 2015. No obstructive CAD was defined as <50% stenosis in any epicardial artery. We compared CMR diagnostic yield in troponin-positive and troponin-negative patients and determined the etiology of presentation in each category. We also examined gender differences. RESULTS: Ninety-eight patients met inclusion criteria. The average age was 55.8 years, 70% were female, and 60% were troponin positive upon presentation. Abnormal CMR was observed in 35.7% of patients, yielding a diagnosis in 27.9% of females and 53.5% of males (P = 0.02). Troponin-positive patients had a significantly higher prevalence of an abnormal CMR than did troponin-negative patients (44.1% vs. 23.1%; P = 0.03). Myocarditis was more common in troponin-positive patients (25.4% vs. 2.6%; P = 0.002). CONCLUSIONS: Forty-four percent of patients with positive troponin and with signs and symptoms suggestive of an ACS, no obstructive CAD on invasive coronary angiography or coronary computed tomography angiogram, and unclear diagnosis had abnormalities on CMR that identified the diagnosis. CMR should be considered in patients with positive troponin values when the etiology for their presentation is unclear.

Sex Differences in Cardiac Medication Use Post-Catheterization in Patients Undergoing Coronary Angiography for Stable Angina with Nonobstructive Coronary Artery Disease.

BACKGROUND: Treatment of patients with stable angina and nonobstructive coronary artery disease (CAD) has not been well characterized. We comparatively evaluated medication use in males and females with stable angina with no CAD, nonobstructive CAD, and obstructive CAD. METHODS: We studied all patients ≥20 years old with stable angina undergoing coronary angiography in British Columbia (BC), Canada, from January 2008 to March 2010 (n = 7,535). No CAD, nonobstructive CAD, and obstructive CAD were defined as 0%, 1%-49%, and ≥50% luminal narrowing in any epicardial coronary artery, respectively. Medication use, 3 months before and 3 months following angiography, was obtained through BC PharmaNet for angiotensin-converting enzyme inhibitors (ACE-I), angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), beta-blockers, statins, antiplatelet agents, and prescriptions for all three ACE-I/ARBs, beta-blockers, and statins (combination therapy). RESULTS: Following angiography, patients with no and nonobstructive CAD had significantly lower rates of prescription use of all medications, including combination therapy, than patients with obstructive CAD (p < 0.001). Use of ACE-I/ARBs, beta-blockers, statins, and combination therapy did not differ by sex, but females had higher use of CCB in all CAD groups, and clopidogrel in nonobstructive and obstructive CAD groups, compared to males. CONCLUSIONS: In patients with stable angina, medication use following angiography is low in nonobstructive CAD with only 58.9% prescribed a statin and 19.4% on combination therapy at 3 months. There are no important sex differences in medication use in any CAD category post-angiography. Future studies should explore methods of improving quality of care in patients with nonobstructive CAD.

Cardiac Medication Use in Patients with Acute Myocardial Infarction and Nonobstructive Coronary Artery Disease.

IMPORTANCE: Patients with acute myocardial infarction (MI) and nonobstructive coronary artery disease (CAD) have an elevated cardiac event rate, suggesting that these patients may benefit from cardiac medication. OBJECTIVE: We evaluated the rates of cardiac medication use 3 months before angiography and 3 months following clinically indicated angiography for MI in patients with no CAD, nonobstructive CAD, and obstructive CAD. We also examined the sex differences in cardiac medication use 3 months following angiography in patients by extent of angiographic CAD. METHODS: We studied patients ≥20 years old with MI undergoing coronary angiography in British Columbia, Canada, from January 1, 2008, to March 31, 2010 (n = 3,841). No CAD, nonobstructive CAD, and obstructive CAD were defined as 0%, 1% to 49%, and ≥50% luminal narrowing in any epicardial coronary artery, respectively. Medication use, 3 months before and 3 months following angiography, was obtained through British Columbia PharmaNet for angiotensin-converting enzyme inhibitors (ACE-Is), angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), beta-blockers, statins, and antiplatelet agents. Optimal medical therapy (OMT) was defined as filled prescriptions for all three: ACE-Is/ARBs, beta-blockers, and statins. RESULTS: Following angiography, in all medication categories except CCBs, patients with no CAD and nonobstructive CAD had significantly lower rates of prescriptions filled than patients with obstructive CAD (all p < 0.001). After adjusting for age and prior medication use, patients with nonobstructive CAD were still less likely to receive these medications than patients with obstructive CAD, including OMT with an odds ratio = 0.25 (95% confidence interval: 0.18-0.36). There were no significant sex differences in medication use 3 months postangiography. CONCLUSIONS: In post-MI patients, medication use following angiography is significantly lower in nonobstructive CAD than obstructive CAD at 3 months. While sex was not an independent predictor of medication use 3 months post-catheterization, future studies should explore methods of improving medication use in both females and males with nonobstructive CAD post-MI.

Sex and Ethnic Differences in Outcomes of Acute Coronary Syndrome and Stable Angina Patients With Obstructive Coronary Artery Disease.

BACKGROUND: The joint contribution of sex, ethnicity, and initial clinical presentation to the long-term outcomes of patients undergoing coronary angiography for acute coronary syndrome (ACS) or stable angina, in whom there is angiographic evidence for obstructive coronary artery disease, remains unknown. METHODS AND RESULTS: We conducted a population-based cohort study on 49 556 adult ACS or stable angina patients with angiographic evidence of obstructive coronary artery disease (≥ 50% stenosis) in British Columbia. The 2-year composite outcome was all-cause death and hospital readmissions for myocardial infarction, heart failure, cerebrovascular accident, or angina after the index angiography. Sex and ethnic differences in the composite outcome were examined by clinical presentation using the Cox proportional-hazards and logistic regression models. Overall, 25.6% were women, 9.5% were South Asians, 3.0% were Chinese, and 65.9% presented with ACS. Regardless of ethnicity, women were more likely than men to have adverse outcomes, but the magnitude of the sex difference was greater in the ACS patients (P(interaction) for sex and clinical presentation=0.03). Angina readmission accounted for 45% of the composite outcome and was the main component for all groups with the exception of Chinese women with ACS. Furthermore, women were more likely than men to be readmitted for angina (odds ratio [95% confidence interval], 1.13 [1.04-1.22]). CONCLUSIONS: Higher rates of adverse events among women with obstructive coronary artery disease, regardless of ethnicity, as well as high rates of angina readmission, highlight the need for more targeted interventions to reduce the burden of angina because this presentation is clearly not benign.

Outcomes and transfer patterns for first Non-ST-elevation myocardial infarction (NSTEMI): comparisons between community and tertiary care hospitals.

BACKGROUND: Transfer patterns, procedure rates, and outcomes of patients with non-ST-segment elevation myocardial infarction (NSTEMI) presenting to Canadian community hospitals are not well understood. METHODS: We documented all patients admitted to British Columbia (BC) hospitals with a primary diagnosis of NSTEMI between 2007 and 2008. Patients were divided by admitting hospital type into tertiary care hospitals, nonremote community hospitals, and remote community hospitals. The aims were to compare transfer rates and time to transfer to a tertiary hospital as well as procedure rates and outcomes at index admission, at 30 days, and at 1 year. RESULTS: The mean transfer rates to a tertiary hospital were 72.6% for nonremote and 57.1% for remote community hospitals (P < 0.001). Times to and rates of cardiac procedures differed significantly among these 3 hospital types. Admission to a nonremote or remote community hospital was associated with similar 1-year mortality compared with admission to a tertiary care hospital (nonremote hospitals, adjusted odds ratio [OR], 0.87; P = 0.26; remote hospitals, adjusted OR, 1.19; P = 0.33). At 1 year, admission to a nonremote community hospital was associated with a lower composite outcome of death or readmission for acute myocardial infarction (AMI) (adjusted OR, 0.80; P = 0.04). CONCLUSIONS: One-year mortality rates were not different between patients with NSTEMI admitted to BC community and tertiary care hospitals; however, the rate of readmission for AMI/death was significantly less in patients admitted to nonremote community hospitals. This should prompt the evaluation of key outcomes in NSTEMI in other community hospital settings.

Brachial artery constriction during brachial artery reactivity testing predicts major adverse clinical outcomes in women with suspected myocardial ischemia: results from the NHLBI-sponsored women's ischemia Syndrome Evaluation (WISE) Study.

BACKGROUND: Limited brachial artery (BA) flow-mediated dilation during brachial artery reactivity testing (BART) has been linked to increased cardiovascular risk. We report on the phenomenon of BA constriction (BAC) following hyperemia. OBJECTIVES: To determine whether BAC predicts adverse CV outcomes and/or mortality in the women's ischemic Syndrome Evaluation Study (WISE). Further, as a secondary objective we sought to determine the risk factors associated with BAC. METHODS: We performed BART on 377 women with chest pain referred for coronary angiography and followed for a median of 9.5 years. Forearm ischemia was induced with 4 minutes occlusion by a cuff placed distal to the BA and inflated to 40mm Hg > systolic pressure. BAC was defined as >4.8% artery constriction following release of the cuff. The main outcome was major adverse events (MACE) including all-cause mortality, non-fatal MI, non-fatal stroke, or hospitalization for heart failure. RESULTS: BA diameter change ranged from -20.6% to +44.9%, and 41 (11%) women experienced BAC. Obstructive CAD and traditional CAD risk factors were not predictive of BAC. Overall, 39% of women with BAC experienced MACE vs. 22% without BAC (p=0.004). In multivariate Cox proportional hazards regression, BAC was a significant independent predictor of MACE (p=0.018) when adjusting for obstructive CAD and traditional risk factors. CONCLUSIONS: BAC predicts almost double the risk for major adverse events compared to patients without BAC. This risk was not accounted for by CAD or traditional risk factors. The novel risk marker of BAC requires further investigation in women.

Sex differences in clinical outcomes in patients with stable angina and no obstructive coronary artery disease.

BACKGROUND: We comparatively evaluated clinical outcomes in men and women presenting with stable angina with no coronary artery disease (CAD), nonobstructive CAD, and obstructive CAD on coronary angiography. METHODS: We studied all patients ≥20 years with stable angina, undergoing coronary angiography in British Columbia, Canada, from July 1999 to December 2002 (n = 13,695) with maximum follow-up to 3 years. No CAD, nonobstructive CAD, and obstructive CAD were defined as 0%, 1% to 49%, and ≥50% luminal narrowing in any epicardial coronary artery, respectively. Freedom from major adverse cardiac events (MACEs), which included the combined end points of all-cause mortality, nonfatal acute myocardial infarction, nonfatal stroke, and heart failure admissions, was estimated using the Kaplan-Meier method. Hazard ratios (HRs) and 95% CIs for MACE were estimated up to 3 years postcatheterization and compared between sex and CAD groups. RESULTS: Within the first year, women with nonobstructive CAD had a higher risk of MACE than men with nonobstructive CAD (adjusted HR 2.43, 95% CI 1.08-5.49). Furthermore, women with nonobstructive CAD had a 2.55-fold higher risk of MACE than women with no CAD (95% CI 1.33-4.88). In contrast, men with nonobstructive CAD had a similar risk as men with no CAD (adjusted HR 0.61, 95% CI 0.26-1.45). The differences in MACE according to extent of CAD were not evident in the longer term. CONCLUSIONS: Women with stable angina and nonobstructive CAD are 3 times more likely to experience a cardiac event within the first year of cardiac catheterization than men. A prospective trial to examine the impact of medical therapy on MACE in patients with nonobstructive CAD is warranted.

Sex differences in coronary catheterization and revascularization following acute myocardial infarction: time trends from 1994 to 2003 in British Columbia.

BACKGROUND: Studies before the turn of the century reported sex differences in procedure rates. It is unknown whether these differences persist. OBJECTIVES: To examine time trends and sex differences in coronary catheterization and revascularization following acute myocardial infarction (AMI). METHODS: A retrospective analysis was performed of all patients 20 years of age or older who were admitted to hospital in British Columbia with an AMI between April 1, 1994, and March 31, 2003. Segmented regression analysis was used to examine the inflection point of the time trend in 90-day catheterization rates post-AMI. Multivariable Cox regression modelling was used to evaluate sex differences in receiving catheterization and revascularization following AMI. RESULTS: Ninety-day coronary catheterization rates increased significantly over the study period for both men and women (P<0.0001 for trend), with a steeper increase beginning in September 2000. Women were less likely to undergo catheterization than men, even after adjustment for baseline differences; this sex effect was modified by age and care in the intensive care unit or cardiac care unit (ICU/CCU). Specifically, ICU/CCU admission eliminated the sex difference among patients who were younger than 65 years of age. Conditional on receiving cardiac catheterization post-AMI, female sex was not associated with a lower likelihood of receiving revascularization within one year (HR 0.96; 95% CI 0.91 to 1.02). CONCLUSIONS: Despite recent increases in catheterization rates post-AMI, women were less likely to undergo catheterization than men. Interestingly, access to ICU/CCU care removed the sex difference in catheterization access in patients younger than 65 years of age.

HISTORIQUE : Les études menées au tournant du siècle faisaient état de différences de taux d'interventions selon les sexes. On ne sait pas si ces différences persistent. OBJECTIFS : Examiner les tendances dans le temps et les différences selon les sexes du cathétérisme coronarien et de la revascularisation après un infarctus aigu du myocarde (IAM). MÉTHODOLOGIE : Les chercheurs ont procédé à une analyse rétrospective de tous les patients de 20 ans ou plus hospitalisés en Colombie-Britannique en raison d'un IAM entre le 1 avril 1994 et le 31 mars 2003. L'analyse de régression segmentée a permis d'examiner le point d'inflexion de la tendance dans le temps des taux de cathétérisme 90 jours après un IAM. Le modèle de régression de Cox multivariable a permis d'évaluer les différences d'administration de cathétérisme et de revascularisation selon les sexes après un IAM. RÉSULTATS : Les taux de cathétérismes coronaires au bout de 90 jours ont considérablement augmenté pendant la période de l'étude, tant chez les hommes que chez les femmes (P<0,0001 en matière de tendance), l'augmentation étant plus marquée à compter de septembre 2000. Les femmes étaient moins susceptibles de subir un cathétérisme que les hommes, même après rajustement des différences de départ. Cet effet attribuable au sexe changeait selon l'âge et les soins à l'unité de soins intensifs ou de soins cardiaques (USI-USC). Notamment, l'hospitalisation à l'USI-USC éliminait la différence selon les sexes chez les patients de moins de 65 ans. Sous réserve d'avoir reçu un cathétérisme cardiaque après l'IAM, le sexe féminin ne s'associait pas à une diminution de la probabilité d'avoir reçu une revascularisation au bout d'un an (FC 0,96; 95 % IC 0,91 à 1,02). CONCLUSIONS : Malgré l'augmentation récente du taux de cathétérisme après un IAM, les femmes étaient moins susceptibles de subir un cathétérisme que les hommes. Fait intéressant, l'accès à l'USI-USC faisait disparaître la différence d'accès au cathétérisme chez les patients de moins de 65 ans.

The ability of heart failure specialists to accurately predict NT-proBNP levels based on clinical assessment and a previous NT-proBNP measurement.

BACKGROUND: The value of routine aminoterminal pro type B natriuretic peptide (NT-proBNP) measurements in outpatient clinics remains unknown. OBJECTIVES: We sought to determine the accuracy with which heart failure (HF) specialists can predict NT-proBNP levels in HF outpatients based on clinical assessment. METHODS: We prospectively studied 160 consecutive HF patients followed in an outpatient multidisciplinary HF clinic. During a regular office visit, HF specialists were asked to estimate a patient's current NT-proBNP level based upon their clinical assessment and all available information from their chart, including a previous NT-proBNP level (if available). NT-proBNP estimations were grouped into prognostic categories (<125, 125-1000, 1000-4998, or >/=4999 pg/mL) and comparisons made between actual and estimate values. RESULTS: Overall, HF specialists estimated 67.5% of NT-proBNP levels correctly. After adjusting for clinical characteristics, knowledge of a prior NT-proBNP measurement was the only significant predictor of estimation accuracy (p=0.01). Compared to patients with a prior NT-proBNP level <125 pg/mL, physicians were 95% less likely to get a correct estimation in patients with the highest prior NT-proBNP level (>/=4999 pg/mL). CONCLUSION: HF specialists are reasonably accurate at estimating current NT-proBNP levels based upon clinical assessment and a previous NT-proBNP level, if those levels were < 4999 pg/mL. Likely, initial but not routine NT-proBNP measurements are useful in outpatient HF clinics.